Patient Forms

We ask that all new patients and patients that have not been seen in the patient 6 months fill out our Medical History Form when they arrive for their appointment.

**Please log into your Patient Portal to update your Health Summary and print this short form below.
Medical History Form for PORTAL Patients  Click Here

If you have chosen not to be on our Patient Portal, please print and complete the form below for your upcoming appointment.
Medical History Form  Click Here

Upon arrival you will be asked to sign and complete demographic information and additional forms via our electronic check-in system.

View-only forms that will be signed electronically at your appointment are:

HIPAA Consent Form — (view only)
HIPAA Privacy Policy — (view only)
Financial Policy — (view only)
Advance Directives — (view only)

*The forms above requires the free Adobe Acrobat Reader, if you do not have Acrobat or need the latest version, click here.

  • Visit one of our five convenient locations in your community:
    To reach any of our offices, call: (336) 768-6211 fax: (336) 768-6869

  • Winston-Salem Office & Endoscopy Center

    Monday-Friday
    Office: 8 am-5 pm
    Endoscopy Center:
    7:30 am-4 pm


    More info »
  • Advance Office
    & Endoscopy Center

    Monday-Friday
    Office: 8 am-4 pm
    Endoscopy Center:
    7 am-4 pm

    More info »
  • Kernersville Office &
    Endoscopy Center

    Monday-Friday
    Office: 8 am-4:45 pm
    Endoscopy Center:
    7:30 am-4 pm

    More info »
  • Thomasville Office &
    Endoscopy Center

    Monday-Friday
    Office: 8 am-4 pm
    Endoscopy Center:
    7:30 am-4 pm


    More info »
  • King Office & Endoscopy Center

    Monday-Friday
    Office: 7:30 am-4 pm
    Endoscopy Center:
    7:30 am-4 pm


    More info »
  • © 2002-2018 Digestive Health Specialists, P.A. | Privacy Policy *Epic and MyChart are registered trademarks of Epic Systems Corporation. Used with permission
  • Interested in a Career with Digestive Health Specialists? Click here >>
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  • Log into Your MyChart*

     

    If you have a MyChart Login please click here

    Otherwise, please call our office at (336) 768-6211 to request an authorization code. 


    *As of February 21, 2018, Digestive Health Specialists, P.A. (DHS) associated with Novant Health Community Connect (NHCC). NHCC allows independently owned physician practices to access shared patient records with other providers within the NHCC and Novant Health System. This allows us to offer you the same individualized specialty care you have come to expect from DHS with enhanced communication between you and our office and between us and your other health care providers.

    One feature we are happy to offer is your new patient portal MyChart. If you are a current Novant Health patient then you may already have access to MyChart and will use your same login information.

    With MyChart you will be able to:

    • View lab results
    • Send messages directly to your care team
    • Request prescriptions

    Thank you for choosing Digestive Health Specialists, P.A. for your care.

    *Epic and MyChart are registered trademarks of Epic Systems Corporation. Used with permission.

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